Case-finding for depression in elderly people: balancing ease of administration with validity in varied treatment settings.

BACKGROUND: Little is known about the performance of brief and ultrabrief (1- and 2-question) depression screens in older patients across varied treatment sites. This study (1) assesses their validity in clinics, hospitals, and nursing homes and (2) assesses cut-points for optimal clinical application.
METHODS: 360 patients aged 60 years and older from 2 urban primary care practices (n = 125), 1 general hospital (n = 150), and 8 nursing homes (n = 85) were assessed using the Yale 1-question screen, the 2-question instrument derived from the Primary Care Evaluation of Mental Disorders, and long and short versions of the Center for Epidemiologic Studies Depression (CES-D) scale and Geriatric Depression Scale (GDS). Sensitivity and specificity were calculated for each screen compared with the criterion standard Diagnostic Interview Schedule (DIS) depression diagnosis and receiver operating characteristic curves generated.
RESULTS: 9% of patients met DIS criteria for major depression and 7% for subsyndromal depression. Overall, the 10-item CES-D showed the best sensitivity/specificity for major depression in clinics (79%/81%) and hospitals (92%/77%), and the short GDS in nursing homes (86%/82%). Specificity of 1- and 2-question instruments was generally low. Established cut-points generally worked best for the short screens, while modifications were useful for longer versions.
CONCLUSIONS: Consideration of site of use is important in selecting brief case-finding instruments for late-life depression, with the 10-item CES-D working best in medical settings and the 15-item GDS in nursing homes.